The Diagnostic Gap

The Lancet Commission on Diagnostics just put a spotlight on the developing world’s alarmingly low access to diagnostics and how this situation can be addressed. 

The LMIC Gap – An unbelievable 47% of the global population has little to no access to diagnostics, with the vast majority of this diagnostic gap concentrated in low and middle-income countries (LMICs). This problem is greatest through LMICs’ primary care facilities (19% of people can access PCs w/ diagnostics), but also exists in hospitals (60%-70% of people can access hospitals w/ diagnostics).

The Impact – About 50% of people living with any of six key conditions in LMICs are undiagnosed (hypertension, type 2 diabetes, HIV, tuberculosis, syphilis & hepatitis B virus infection in pregnant women), making diagnostic access the world’s single greatest barrier to care. If undiagnosed rates for these six conditions were reduced to 10% in LMICs, it would avoid 1.1m premature deaths annually.

The Imaging Gap – There is a significant lack of imaging access in LMICs. Imaging access is lowest in primary care where only 5% of basic facilities and 12% of advanced facilities have ultrasound (never mind more advanced imaging). Meanwhile only 36% to 87% of hospitals in LMICs have working X-ray systems and just 2% to 29% of hospitals have a CT scanner (depending on the country).

The Problem – The authors largely blamed the developing world’s diagnostic gap on a lack of visibility and prioritization, although there’s a long list of other factors (corruption, costs, infrastructure, workforce).

The Solutions – The Lancet Commission believes that recent technology and informatics innovations could accelerate government efforts to improve diagnostic access. Until then, they recommend that LMICs develop national diagnostics strategies, ensure that standard diagnostic tests are available at various healthcare tiers (e.g. ultrasound at all primary care facilities), and prioritize improving diagnostic access through primary care facilities.

One Takeaway – Half the world doesn’t have access to diagnostics. This is mainly an economic problem, but imaging could play an outsized role in the solution considering that many of the latest imaging innovations are well suited for low-resource areas (e.g. handheld POCUS, AI diagnostics/guidance, portable MRI, teleradiology, etc.).

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-- The Imaging Wire team